4/3/2018 The Eight Principles of Diagnosis in Traditional Chinese Medicine

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The Eight Principles of Diagnosis in

Traditional Chinese Medicine
Posted August 30, 2017 by Acupuncture & Massage College

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In a previous article, we discussed the notion of health and illness in Traditional Chinese
Medicine (TCM). According to TCM, illness arises as a result of speci c yin-
yang imbalances of the Functional Entities. 

The functional entities are:

1. The Five Fundamental Substances: Qi, Xue (Blood), Jinye (Body Fluids), Jing
(Essence), and Shen (Spirit).
2. Zang-fu: A Wu Xing cycle of 5 zang organs, 6 fu organs, and their functions
3. Jing-luo: The channels or meridians through which qi ows

The functional entities are responsible for performing the  ve cardinal functions that
maintain health within the body. They are: Actuation, Warming, Defense, Containment,
and Transportation.

If there is an imbalance within the any of the functional entities, they will not be able to
perform their cardinal functions, and as result, illness may arise.

As mentioned previously, Oriental Medicine does not evaluate an illness purely based on
the symptoms a person is showing, but rather, on complex patterns of disharmony in the
body.

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4/3/2018 The Eight Principles of Diagnosis in Traditional Chinese Medicine

At the most basic level, these patterns are determined by Eight Principles, which measure
either an excess (vacuity) or de ciency (stagnation) of qi in one the entities.

In this article, we will discuss the eight principles of diagnosis in Traditional Chinese
Medicine.

The process of determining the actual pattern of diagnosis begins with an evaluation of
bing according to the notion of the Eight Principles. The Eight Principles describe the basic
qualities of a disease. This notion refers to four pairs of mutual opposites.

The Eight Principles (辩证) are:

1. Yin: Yin, along with yang is the most general classi cation for pattern diagnosis and it
describes the relationship between the other three pairs of the Principles. Generally
speaking, yin is Cold.

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4/3/2018 The Eight Principles of Diagnosis in Traditional Chinese Medicine

2. Yang: Yang, along with yin is used to describe the relationship between the other three
pairs of the Principles. For example, Heat is Yang.

3. Interior: Interior describes diseases that manifest themselves in the Zang-fu organs or
deep inside the body, such as qi, blood, and bone marrow. More broadly, it used to
describe diseases that cannot be classi ed as Exterior.

4. Exterior: Exterior describes diseases that manifest themselves on surface of the body,
such hair, skin, nails, and meridians. Its clinical features include body chills, fever, aversion
to cold temperatures and winds, a weak pulse, and headaches.

5. Heat: Heat describes the absence of an aversion to Cold. If paired with an Exterior
pattern, its symptoms can include a rapid pulse, fever, body chills, dehydration, and a
sore throat. If paired with an Interior patter, its symptoms can include a preference for
cold drinks, clear urine, and a slow pulse.

6. Cold: Cold describes an aversion to cold. If paired with an Exterior pattern, its
symptoms can include body aches, a tense pulse, fever, body chills, and headaches. If
paired with an Interior patter, its symptoms can include nausea, stomach pain, vomiting,
and diarrhea.

7. De ciency: De ciency is used to describe a vacuity in qi, blood (Xue), or body uids
(Jinye). Depending on how it relates to Interior/Exterior and Cold/Heat, it can manifest
as constipation, having a small appetite, dizziness, and slow pulse.

8. Excess: Excess is generally classi ed as any disease that can't be identi ed as a

De ciency pattern. Usually, it means that one of the Six Excesses is present. Depending
on how it relates to Interior/Exterior and Cold/Heat, it can manifest as quick pulse,
sweaty palms, and sharp stomach pains.

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4/3/2018 The Eight Principles of Diagnosis in Traditional Chinese Medicine

After a basic diagnosis of the diseases is given via the Eight Principles, the diagnostic
continues and focuses on more speci c conditions. After evaluating the present
symptoms, a person’s condition is further evaluated as to how the speci c entities (qi,
meridians, Zang-fu, etc.) are a ected.

Cause of Disease

Traditional Chinese Medicine does not strongly di erentiate between the cause and
e ect of a disease. However, there are three major categories that are considered to give
rise to disease. The three major categories of disease causes are:

1. External: Disease caused by the Six Excesses and bad qi.

2. Internal: Disease caused the by Seven Emotions or Seven A ects: Anger, Fear,
Anxiety, Fright, Grief, Pensiveness, and Joy. These are said to e ect the zang-fu organs.

3. Other Irregularities-Disease caused something that is neither external nor internal, such
as having unbalanced diet or damage done by parasites.

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4/3/2018 The Eight Principles of Diagnosis in Traditional Chinese Medicine

Four Pillars of Diagnosis

There are four methods of diagnostics in Traditional Chinese Medicine, which are often
referred to as the Four Pillars of Diagnosis. They are:

1. Inspection: Inspection or “looking” focuses on visual analysis of the face, skin features,
and particularly, the tongue. In TCM, the surface of the tongue corresponds to particular
zang-fu organs and can reveal a lot about a particular disease. Therefore, the tongue
diagnosis is considered a cornerstone practice in the diagnostic process.

2. Auscultation: Auscultation refers to the analysis of particular sounds. In TCM, there are
ve major types of sounds: shouting, laughing, singing, weeping, and groaning.
Auscultation analysis extends to olfaction, which analyzes the smell of body odor, even
though sound and smell are consider to be separate senses in the West.

3. Palpation: Palpation refers to analysis by feeling, particularly the wrist pulse, abdomen,
and meridians points. The techniques for doing are complex and can years to learn.

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4/3/2018 The Eight Principles of Diagnosis in Traditional Chinese Medicine

4. Inquiry: Inquiry refers to analysis by asking questions about the person’s past health
and habits. Traditionally, this included 10 questions, which ranged from diet to sleep
pattern.

After recognizing a particular pattern of disharmony, a doctor will prescribe treatment

based on the diagnosis that was given. The treatment can include the more common
practices of Traditional Chinese Medicine, such as herbal medicine, acupuncture, and tui
na massage, but also less common practices, such as cupping.

In the next article of the series, we will discuss the di erent modalities of healing in
Traditional Chinese Medicine.

While learning the speci c elements of TCM diagnosis and treatment can take several
years, our Master’s in Oriental Medicine program is designed to be completed in just
three. If you’re interested in learning more about a career in acupuncture and Oriental
Medicine, download our free career guide below. Our school is located in Miami, FL.

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